Case Report of the surgical management of small bowel and colonic ischaemia associated with Anorexia Nervosa binge/purge subtype

Abstract

HighlightsAnorexia nervosa is common, it has two subtypes; restrictive and binge/purge.Ischaemic bowel associated with anorexia nervosa is rare but potentially life-threatening.The mechanism of ischaemic bowel in anorexia nervosa has not been fully elucidated.This condition should be highlighted as it has a high associated mortality.Prompt involvement of radiology and surgery appears pivotal to outcome.

Necrotising enterocolitis in an adult with anorexia nervosa

“…15,16 Histologically, NEC presents a picture of mucosal infarction often extending to transmural necrosis. 1,3,10 However, as in our patient, several pathology reports of samples taken during laparotomy revealed no occlusion of the mesenteric arteries supplying the portion of ischaemic bowel, 3,9,10 suggesting an alternative mechanism to the thrombotic histology reported by Foran et al 17…”

“…Yamada et al attribute low flow in their case to mesenteric vasoconstriction brought about during resuscitative inotropic support. 10 While Foran et al describe a large binge eating session triggering their case of 17 half of all cases reviewed appeared to follow the start of enteral nutrition after a prolonged period of starvation, a phenomenon also seen in our patient. Strand et al highlight a knock-on sequence of events linking circumstantial enteral nutrition with the onset of NEC.…”

“…In addition, it is wise to continue to hold a high suspicion for necrosis after initial resection of the ischaemic segment. Relook laparotomy was necessary both in our patient and in several others to resect further bowel and for washout of peritonitic fluid, 17,20 the failure of which may have contributed to the death of patients in other cases. 2,9,10 However, despite striving for fast diagnosis, a successful surgical outcome is ultimately dependent on the patient's resilience and physiological reserve.…”